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General NPI Number Information
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NPI Number | 1265070452
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Entity Type | Organization
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Legal Business Name | BRAIN CLOUD DIAGNOSTICS
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 9727 ELK GROVE FLORIN RD STE 160
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City | ELK GROVE
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State | CA
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Zip | 95624-2291
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Country | US
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Telephone | 916-864-3066
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Fax |
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Provider Business Mailing Address
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Address Line | 9727 ELK GROVE FLORIN RD STE 160
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City | ELK GROVE
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State | CA
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Zip | 95624-2291
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Country | US
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Telephone | 916-864-3066
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. AMIR A BAIG
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Credential | R. EEG T, MHA
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Telephone | 916-864-3066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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